Allen Taryn M, Struemph Kari L, Toledo-Tamula Mary Anne, Wolters Pamela L, Baldwin Andrea, Widemann Brigitte, Martin Staci
Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, U.S.A.
Health Psychology and Neurobehavioral Research Group, National Cancer Institute, Bethesda, Maryland, U.S.A.
Pain Pract. 2018 Nov;18(8):969-978. doi: 10.1111/papr.12695. Epub 2018 Apr 23.
Individuals with neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PNs) can experience chronic pain. Previous research has examined the relationship between heart rate variability (HRV) and persistent pain. HRV is an index of autonomic nervous system functioning, and reflects the variability in time elapsed between heartbeats. Patients with chronic pain tend to exhibit lower HRV, which has been associated with poor adaptability, or psychological flexibility, to stress. The aim of the current study was to examine relationships between HRV, psychological flexibility, and pain in a sample of adolescents and young adults (AYAs) with NF1 and PNs. AYA participants (n = 40) 16 to 34 years of age with NF1 completed baseline measures of pain and psychological functioning, and underwent a 5-minute electrocardiogram (ECG). A subset of 20 participants completed follow-up questionnaires and a second ECG 8 weeks later. Spectral analyses of ECGs yielded a measure of high-frequency heart rate variability (HF-HRV). Baseline correlations revealed that lower HF-HRV is related to greater inflexibility and more pain interference, but not pain intensity. Moreover, psychological inflexibility significantly mediated the relationship between HF-HRV and pain interference. Finally, regression models indicated that baseline psychological inflexibility is a significant predictor of HF-HRV at follow-up and, separately, that baseline HF-HRV significantly predicted pain intensity at follow-up. These findings suggest complex mind-body processes in the experience of pain in NF1, which have not been studied previously. Implications for pain-related interventions and future research are discussed.
患有1型神经纤维瘤病（NF1）和丛状神经纤维瘤（PN）的个体可能会经历慢性疼痛。先前的研究已经探讨了心率变异性（HRV）与持续性疼痛之间的关系。HRV是自主神经系统功能的一个指标，反映了心跳之间的时间间隔变化。慢性疼痛患者往往表现出较低的HRV，这与对压力的适应性差或心理灵活性差有关。本研究的目的是在患有NF1和PN的青少年和青年（AYA）样本中，研究HRV、心理灵活性和疼痛之间的关系。16至34岁患有NF1的AYA参与者（n = 40）完成了疼痛和心理功能的基线测量，并进行了5分钟的心电图（ECG）检查。20名参与者的一个子集在8周后完成了随访问卷和第二次ECG检查。对ECG进行频谱分析得出了高频心率变异性（HF-HRV）的测量值。基线相关性分析显示，较低的HF-HRV与更大的不灵活性和更多的疼痛干扰有关，但与疼痛强度无关。此外，心理不灵活性显著介导了HF-HRV与疼痛干扰之间的关系。最后，回归模型表明，基线心理不灵活性是随访时HF-HRV的一个显著预测因素，另外，基线HF-HRV显著预测了随访时的疼痛强度。这些发现表明，NF1疼痛体验中存在复杂的身心过程，而此前尚未对此进行过研究。本文讨论了与疼痛相关干预措施的意义及未来研究方向。
